Asynchronous Intro to Patho/Pharm

Health: state of complete

physical, mental, and social well-being and not merely as the absence of disease or infirmity

Disease:

a biologic or psychologic alteration that results in a malfunction of a body organ or system

Illness:

a sickness or deviation from a healthy state; the term has a broader meaning than disease

Illness Terminology

• Acute

  • Typically

  • Patient recovers back to

• Subacute

  • Longer than

• Chronic

  • Present for

  • May have periods of

  • May include

  • We have seen a shift from

• Acute

  • Typically short lived, self-limiting, and responds to specific treatment​

  • Patient recovers back to their previous health status (full recovery), typically in a predictable sequence

• Subacute

  • Longer than a few days but shorter than several months

• Chronic

  • Present for longer period of time​

  • May have periods of worsening (can be acute or subacute)​

  • May include permanent disability, long-term medical management of physical/cognitive problems​

  • We have seen a shift from communicable chronic diseases to non-communicable

Etiology

disease causation

idiopathic

unknown cause

iatrogenic

effect of medical treatment

pathogenesis

how disease develops

• Signs

• Symptoms

• These are

• Signs

  • what can be seen and measured

• Symptoms

  • what the patient describes

• These are manifestations of disease

Syndrome

groups of signs and symptoms that occur together

remission

manifestations occur

exacerbation

manifestations of an existing disease/condition increase

Psychosocial Aspects of Illness

• Personality type will play a role in recovery (independent vs. dependent)​

• Fear, anxiety, denial

Disability

• An individual with a disability is defined by the ADA as a person who has a

• _____, _______ domains​

• Not all disabilities are _____

• An individual with a disability is defined by the ADA as a person who has a physical or mental impairment that substantially limits one or more major life activities, a person who has a history or record of such an impairment, or a person who is perceived by others as having such an impairment.

• Physical, cognitive domains​

  • Memory, executive function, processing issues, ability to learn, problem solving, behavior issues​

• Not all disabilities are visible

Health state of an individual

Factors:

• genetic influence

• cognitive abilities

• age

• sex

• environment, life style

• geographic location

• culture

• religion

• standard of living

• health beliefs, practices

• previous health experiences

• support systems

Role of PT in Health Promotion and Disease Prevention

• Primary

• Disease prevention​

• Who may be susceptible to a given disease?​

• Risk factor assessment​

• Wellness activities​

• Removing or reducing risk factors

Role of PT in Health Promotion and Disease Prevention

• Secondary

• Tertiary

• Secondary

  • early disease detection

  • Screening programs​

• Tertiary

  • limiting the impact of established disease

Genetic Aspects of Health and Disease

• Individual

• Impact of

• Genetic variations may make one more susceptible to certain

• We need to be prepared to

• Individual genetic differences/variation​

• Impact of family history on acquiring disease and disease progression​

  • HTN​

  • Stroke​

  • Alzheimer disease​

  • Parkinson disease​

  • OA​

• Genetic variations may make one more susceptible to certain diseases/severity of disease/disease progression/response to physical therapy interventions ​

• We need to be prepared to support our patients with hereditary disease patterns and or/that undergo genetic testing

Epigenetics

• Looks at how biology and the

• Looks at how biology and the environment exert their effects on a person and how genes express themselves​

  • SDOH​

  • Lifestyle choices

Other variations in client presentation

• Race and ethnicity

• Gender

• Race and ethnicity

  • Biology is not the causative factor as to why some groups experience some diseases more commonly​

    • Related more to social and cultural influences

• Gender

  • Are some biological differences, but epigenetics also play a large role​

    • Gender as a social construct​

    • What is a child exposed to at an early age? ​

    • Stigma of LGBTQ status and stress

Other Epigenetic Influences

• Nutrition​

• Obesity​

• Physical activity levels​

• Smoking/Tobacco/ETOH/Other drugs

What does this mean for us as physical therapists?

• Need to understand how disease and the

• Need for

• Need to understand how disease and the movement system are related, and how this may change across the lifespan​

• Need for individualized attention and prescription for our patients​

  • Person centered care​

  • Understanding the role of the patient’s physical, social, emotional, psychological systems and how we can best support the patient on all levels​

  • Understanding how cultural beliefs may alter therapy (ie. No blood transfusions for Jehovah witnesses; fasting for religious reasons)

Reasoning for learning about pharmacology

• Your patients/clients may be taking over the counter or prescription medications​

• Want to avoid adverse interactions between medications and PT interventions​

• Timing of sessions with respect to drug administration for optimal participation

Pharmacology subgroups

• Pharmacotherapeutics

• Toxicology

• Pharmacotherapeutics subgroups

• Pharmacokinetics

• Pharmacodynamics

• Pharmacokinetics

• Pharmacodynamics

• Pharmacokinetics

  • how the body deals with the drugs

• Pharmacodynamics

  • what the drug does to the body

Pharmacokinetics subgroups

• Absorption

• Distribution

• Elimination

Also includes administration and metabolism

Pharmacodynamics subgroups

• Systemic effects

• cellular effects

Example: Ibuprofen

• Pharmacotherapeutics:

• Pharmacokinetics:

• Pharmacodynamics:

• Pharmacotherapeutics: reduces hormones to decrease pain and inflammation ​

• Pharmacokinetics: p.o. administration; absorbed in stomach; excreted through metabolism and urine​

• Pharmacodynamics: decrease in pain, fever, inflammation

Drug Nomenclature

• Chemical name

• Generic name (official name)

• Trade name (brand name)

• Chemical name​

  • (RS)-2-(4-(2-methylpropyl)phenyl)propanoic acid​

• Generic name (official name)​

  • ibuprofen​

• Trade name (brand name)​

  • Advil TM​

  • Motrin TM

Prescription vs. Over-the-Counter

• Prescription​

  • Requires order and dispensing by

• Over-the-Counter (OTC)​

  • Non-

  • Consumer can

  • Usually for more

  • Can still be

  • We need to be asking about what patients are

• Prescription​

  • Requires order and dispensing by authorized practitioner​

    • MD, dentist, APRN, PA to name a few​

• Over-the-Counter (OTC)​

  • Non-prescription​

  • Consumer can directly purchase​

  • Usually for more minor issues and have less toxicity risk​

  • Can still be abused​

  • We need to be asking about what patients are taking and educating them appropriately​

***WE CANNOT PRESCRIBE OR ADMINISTER OTC DRUGS***

Common Abbreviations

• bid

• hs

• q

• qid

• tid

• prn

• p.o.

• bid

  • twice daily

• hs

  • at bedtime

• q

  • every/each

• qid

  • four times daily

• tid

  • three times daily

• prn

  • as needed

• p.o.

  • by mouth

Concepts in Drug Therapy

• We need the drug to be able to reach the

• Then, the drug needs to be able to

• Need to give enough drug so that the

• ….but don’t want too much of the drug and have

• ​_____-_____ RELATIONSHIP

• We need the drug to be able to reach the target cell or tissue​

• Then, the drug needs to be able to exert its effect on that tissue​

• Need to give enough drug so that the benefit of the drug can be exerted….​

• ….but don’t want too much of the drug and have toxic effect​

• ​DOSE-RESPONSE RELATIONSHIP

Dose Response Curve

• Dose/Dosage​

  • Enough to

  • Minimal ​

• Ceiling effect or maximal efficacy​

  • No greater

• Dose/Dosage​

  • Enough to do the job intended​

  • Minimal toxic effects​

• Ceiling effect or maximal efficacy​

  • No greater effect of the drug is noted if dosage is increased

Potency

• Potency is related to the dose that produces a given response in a specific amplitude.

• A smaller dosage of the blue drug will be needed to reach the desired response than the green or red drug.

Therapeutic index

• TI is used to calculate

• Drugs such as chemo have a

• In some cases of drugs with a low TI, blood levels may be monitored to decrease risk for

• TI is used to calculate drug safety; higher TI = safer drug​

• Drugs such as chemo have a low TI, but in most cases the benefits of taking it outweigh the potential negative effects​

• In some cases of drugs with a low TI, blood levels may be monitored to decrease risk for toxicity